Governor McDonnell proposes new mental health funding

Gov. Bob McDonnell said Tuesday that he would add more than $38 million for mental health services in the two-year budget he will present to the General Assembly next week.

The funds would be divided among crisis response, expanded outpatient services, and opening 20 beds at Eastern State Hospital, a state psychiatric facility in Williamsburg.

McDonnell also issued an executive order establishikng a task force on mental health, calling on all stakeholders, including patients and their families, "to seek and recommend solutions" to improve Virginia's crisis services.

The governor's actions came three weeks after state Sen. Creigh Deeds, a long-time political rival, was stabbed by his mentally ill son, who then took his own life.

"We must increase the capacity and availability of those services in all Virginia communities, so that every person in crisis is able to receive much-needed help," McDonnell said. Gov.-elect Terry McAuliffe, who takes office in January, issued a statement supporting McDonnell's proposals.

Chuck Hall, director of the Hampton-Newport News Community Services Board, likened McDonnell's actions to the boost after the Virginia Tech shooting in 2007. "It's in response to a crisis. They've got everything in there, but it has to be considered a drop in the bucket. It's not the solution," he said, while acknowledging the funds as an important step.

On Nov. 19, Austin "Gus" Deeds, 24, stabbed his father several times before fatally shooting himself. The day before, the younger Deeds had been evaluated and held under an emergency custody order, an ECO, while the local community services board searched for a suitable psychiatric bed for him. Failing to find one, when the six-hour limit on the ECO ran out, Deeds was released. Had a bed been available, he could have been held for up to 48 hours under a temporary detention order, or TDO.

The governor said his proposed budget will include funding to extend the hours allotted for ECOs from six to eight, and for TDOs from 48 to 72 hours.

Last week, an internal status report by the state's Department of Behavioral Health and Developmental Services triggered by the Deeds' tragedy, noted that in more than 270 cases last year, it took more than 16 hours to find a TDO hospital bed.

In spring 2012, the behavioral health department's inspector general outlined the problems attendant on both the execution of TDOs and the shortage of psychiatric beds in the state. The report, based on a three-month study, said 72 individuals meeting TDO criteria fell through the cracks when no beds could be found for them in either state-operated hospitals or private psychiatric facilities.

The report, led by G. Douglas Bevelacqua, indicated that the 2010 downsizing of Eastern State had precipitated many of the problems in Hampton Roads for finding appropriate treatment for those in crisis. The 2012 report recommended streamlining protocols for medical screening and partnering with private psychiatric facilities to establish "intensive psychiatric beds" until the state re-created a reliable safety net.

Last week's update reiterated those recommendations. It said regional data collection on unexecuted and delayed TDOs would start in January 2014 and a new position would be created to monitor them.

The update revealed that not all regions had written protocols for the role of hospitals and the community services board, and promised to correct that by Jan. 15. The department "will speed up efforts to specify clear and specific statewide expectations for securing a psychiatric bed when an individual qualifies for a TDO," spokeswoman Meghan McGuire said in an email.

As part of the governor's funding proposal, Eastern State receives the biggest outlay, $14.4 million over two years, to accommodate a switch of 20 currently vacant beds from Medicaid-funded geriatric care to civil and forensic patients. The hospital has a 300-bed capacity, about half reserved for geriatric patients.

"This region has already been in negotiation about those 20 beds," Hall said. Ideally, he'd like to see the remaining geriatric beds divided 60/40 among high-demand civil and forensic patients. David Lyon, director of the hospital, could not be reached for comment.

Hall emphasized the importance of bolstering mental health outpatient services. "I think that's the area most in need of funding," he said.

David Coe, his counterpart at Colonial Behavioral Health serving several Peninsula communities, agreed. "The focus needs to be on preventing crisis. We need more housing, employment and wrap-around services," he said.

Both CSB directors agreed that McDonnell's proposed $38 million was promising, but said it merely scratches the surface in terms of overall need.

To see McDonnell's budget proposals for mental health, go to http://www.dailypress.com/health.